Teach for the World

The words spoken by physicians carry weight and significance, but as first year residents we might not always appreciate and effectively use this fact. Too often we are prompted to go to the bedside of a patient by a nurse’s page or request stating “The patient wants to speak with you,” often without further explanation divulged.  At 3AM, it is easy for us to attribute these calls to laziness on the part of the nurse. However, nurses often feel disempowered: in many hospitals, physicians rarely take the time to share their treatment plans or diagnostic explorations with the nurses who are charged with handling the logistics and details of minute-by-minute patient care, and patients in these settings often do not trust or expect their nurses to have the answers to their questions. To further worsen matters, at my hospital nurses are typically given the task of discharging patients which includes reviewing medication lists and upcoming appointment times. “Discharging,” however, should also include debriefing patients on their hospitalization, their illnesses, and their immediate (if not long term) outpatient treatment strategies. Although sometimes quite experienced and knowledgeable, many of our nurses are not necessarily equipped with the general medical knowledge or knowledge specific to individual patients to carry out this task. Furthermore, my hospital’s Medicine service discharge paperwork does not include an area for patient instructions (the Emergency Room does include instructions in their discharge papers).  To make matters worse, interns receive little to no training on how to properly discharge or educate patients. As with the emphasis on the dismount from the balance beam in gymnastics, the discharge process can make or break a performance –  in this case, the performance is the sustaining of the patient’s recovery from illness beyond the hospitalization.

Patient education by physicians, even in brief measures, can be a powerful tool for enacting change. For example, in tobacco cessation counseling, the mere act of advising patients against tobacco use without extensive explanation or justification can significantly increase the odds of a patient quitting tobacco. In much the same way, most of the patient education I deliver on the inpatient services occurs through repeating teaching points during brief daily encounters. I would love to be able to spend fifteen to twenty minutes sitting down with each patient at the time of discharge to debrief and educate them, but in reality, the time demands of my intern year have only allowed me to debrief the patients with the most critical needs for further education. Fortunately, in my residency program, many of the second and third year residents are proactive and see patient teaching as one of their responsibilities, so most patients will receive some degree of teaching from either the intern or resident (and sometimes the hands-on attending).

I continue to search for my strengths and passions among my evolving roles as a young physician: by necessity we wear many hats, but we choose which skills to hone and use most often. There is much interest in medical writing and journalism at this time because for many years there was an incredible dearth of adequate, accurate reporting of medical science discoveries and treatment changes and their impact on health. There is a growing influx of medical writers who are better educated and more familiar with medicine. In theory, this should have a powerful impact on educating patients and the general public. However, I worry that just as physicians are spending more of their time in front of the computer screen instead of by the bedsides of their patients, we may also spend too much time writing words and advice instead of speaking to and educating our patients, their families, and our communities in person (except in the context of increasingly brief hospital stays and primary care visits).  A piece of paper or words on a screen do not carry the same weight as words delivered through the voice of a trusted advisor, a professional and known expert – your physician.

To this end, health education, through teaching patients and their families directly and through teaching students and medical professionals to teach more effectively, may become an important component of my personal mission in medicine. We need to get out there more, and by “out there,” I mean out of our offices and hospitals and into the lives of the people whom we are entrusted to treat and heal.

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